Longitudinal relationships between depression and functioning in people with type 2 diabetes.

BACKGROUND: The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood. PURPOSE: The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes. METHODS: Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n = 1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II. RESULTS: Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments. CONCLUSIONS: Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.

Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review.

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established.

Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women.

Healthy diet and physical activity are associated with a lower cardiometabolic risk (CMR). Little is known about whether they interact to improve CMR. The purpose of the present study was to determine the synergistic associations of diet quality and physical activity energy expenditure (PAEE) on CMR factors. The present study was an a posteriori analysis of two cross-sectional studies on 124 inactive non-diabetic postmenopausal women with a BMI ≥ 27 kg/m². The following factors were measured: diet quality (assessed by the Canadian Healthy Eating Index (C-HEI) from a 3 d food record); PAEE (doubly labelled water); body composition (dual-energy X-ray absorptiometry, computed tomography scan); lipoprotein profile (total, HDL- and LDL-cholesterol (HDL-C and LDL-C), non-HDL-C, total cholesterol:HDL-C, TAG, apoA1, apoB, apoA1:apoB and LDL-C:apoB); insulin sensitivity (homeostasis model assessment of insulin resistance and hyperinsulinaemic-euglycaemic clamp); inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), haptoglobin, orosomucoid, IL-6 and leucocyte count). The association of the interaction PAEE × C-HEI and CMR factors was evaluated by hierarchical regressions. Fat mass-adjusted ANCOVA determined the interaction between PAEE and the C-HEI. In hierarchical regressions, the interaction PAEE × C-HEI was a correlate of more favourable values of HDL-C, apoB, apoA1:apoB and LDL-C:apoB ratios, and hs-CRP, while only PAEE was a negative correlate of haptoglobin. Compared with those in the low-PAEE/low-C-HEI group, women in the high-PAEE/high-C-HEI group had 10 % higher HDL-C, 13 % lower apoB, 11 % larger LDL particles and 28 % lower hs-CRP concentrations (P< 0·05). PAEE and the C-HEI have a synergistic association with the CMR profile. These results support the integration of both diet quality and physical activity in the management of CMR.

Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec.

BACKGROUND: The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear. OBJECTIVE: The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada. METHOD: Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability. RESULTS: The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men. DISCUSSION: Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.

Anthropometric, metabolic, psychosocial and dietary factors associated with dropout in overweight and obese postmenopausal women engaged in a 6-month weight loss programme: a MONET study.

The objective of the present study was to examine anthropometric, metabolic, psychosocial and dietary factors associated with dropout in a 6-month weight loss intervention aimed at reducing body weight by 10 %. The study sample included 137 sedentary, overweight and obese postmenopausal women, participating in a weight loss intervention that consisted of either energy restriction (ER) or ER with resistance training (ER+RT). Anthropometric (BMI, percent lean body mass, percent fat mass, visceral adipose tissue and waist circumference), metabolic (total energy expenditure, RMR, insulin sensitivity and fasting plasma levels of leptin and ghrelin), psychosocial (body esteem, self-esteem, stress, dietary restraint, disinhibition, hunger, quality of life, self-efficacy, perceived benefits for controlling weight and perceived risk) and dietary (3-d food record) variables were measured. Thirty subjects out of 137 dropped out of the weight loss programme (22 %), with no significant differences in dropout rates between those in the ER and the ER+RT groups. Overall, amount of weight loss was significantly lower in dropouts than in completers ( - 1.7 (sd 3.5) v. - 5.6 (sd 4.3) kg, P < 0.05); weekly weight loss during the first 4 weeks was also significantly lower. Dropouts consumed fewer fruit servings than completers (1.7 (sd 1.1) v. 2.7 (sd 1.53), P < 0.05) and had higher insulin sensitivity levels (12.6 (sd 3.8) v. 11.1 (sd 2.8) mg glucose/min per kg fat-free mass, P < 0.05). The present results suggest that the rate of weight loss during the first weeks of an intervention plays an important role in the completion of the programme. Thus, participants with low rates of initial weight loss should be monitored intensely to undertake corrective measures to increase the likelihood of completion.

Effects of the addition of a resistance training programme to a caloric restriction weight loss intervention on psychosocial factors in overweight and obese post-menopausal women: a Montreal Ottawa New Emerging Team study.

The aim of this study was to examine the effects of the addition of a resistance training programme to a caloric restriction weight loss intervention on psychosocial profile. The study sample consisted of 137 overweight and obese post-menopausal women. Participants were randomized to a caloric restriction group and caloric restriction + resistance training group. Psychosocial, anthropometric, and metabolic variables were measured before and after the 6-month weight loss intervention. Both groups presented similar weight loss and there were no significant differences between the caloric restriction group and caloric restriction + resistance training group for changes in psychosocial profile. Thereafter, all participants were classified into quintiles based on the amount of weight loss. In all quintiles, women markedly improved body esteem and self-esteem, and decreased hunger and perceived risk for diabetes mellitus (P < 0.05). However, significant increases in dietary restraint were observed in quintiles 2-5 (> or =2.4 % body weight loss), decreases in disinhibition in quintiles 3-5 (> or =4.9 %), increases in self-efficacy in quintiles 3-5 (> or =4.9 %), and increases in health perceptions in quintile 5 (> or =11.1%). The results of this study do not support the hypothesis that the addition of a resistance training programme to a caloric restriction weight loss intervention has additional benefits on psychosocial profile. Overall, the significant improvements in the psychosocial profile observed were mostly accounted for by the degree of weight loss.

French adaptation of the eating disorder recovery self-efficacy questionnaire (EDRSQ): psychometric properties and conceptual overview.

High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self-efficacy is a key motivational factor in the recovery from EDs. A self-report measure, the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ-F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non-clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ-F and measures of ED symptoms, depression and self-esteem. A confirmatory factor analysis (CFA) revealed a bi-factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ-F and suggest it is a useful instrument for the assessment of EDs.

Exploring adolescents' awareness of diabetes using the free association technique.

PURPOSE: Healthy adolescents' awareness of diabetes was explored, and gender and grade-level differences in understanding were determined. METHODS: Adolescents without diabetes in grades five, eight, and 10 (n=128) at four New Brunswick schools wrote down all words/expressions that came to mind when they heard the word "diabetes" (i.e., they used the free association technique). Answers were classified into categories using content analysis. RESULTS: Eighty-eight girls and 40 boys completed the activity (n=44, 52, and 32 in grades five, eight, and 10, respectively). Nine principal categories were identified: 66% of the adolescents cited sugar (e.g., eating too much sugar, not enough sugar), 48% treatment (e.g., needles, injections), 45% the nature of diabetes (e.g., a disease, types of diabetes, heredity), 41% nutrition (e.g., diet, sugar-containing foods, other foods), 38% blood (e.g., too much/not enough sugar in blood), 18% complications (e.g., death), 11% physiological manifestations/symptoms (e.g., fainting), 6% obesity, and 6% physical activity. No differences were found in category citation frequency between boys and girls and grade levels, except that grade 10 students more frequently cited the categories of treatment, blood, and obesity (p=0.05). CONCLUSIONS: Students thought of diabetes in terms of sugar and injections. Words related to obesity, prevention, and complications were cited infrequently.

Healthy adolescents' social representations of diabetes.

OBJECTIVE: This study explores healthy adolescents' social representations of diabetes in terms of its definition, origins and prevention. METHODS: Focus groups were conducted with students in Grades 5, 8 and 10 from 4 francophone schools in New Brunswick, Canada. Audiotaped discussions were transcribed and categorized using qualitative content analysis (Atlas.ti software). Chi-square and Fisher's exact tests were used to determine sex and grade-level differences in frequency of category citations. RESULTS: Nineteen focus groups involved 130 adolescents. Students defined diabetes as a disease (13 groups) related to sugar (15 groups) and blood (13 groups), but only a few mentioned the role of insulin/pancreas, types of diabetes and/or complications. Symptoms/physiological manifestations (11 groups), monitoring blood sugar (10 groups) and insulin injections (5 groups) were discussed primarily in terms of behaviours observed among family and friends with diabetes, demonstrating the importance of social environment in their representations. Half of the groups identified heredity, age, obesity, physical activity and poor diet as playing a role in developing diabetes. Students had a general idea about the importance of good eating habits and physical activity in terms of managing and preventing diabetes. Eleven groups had the misconception that sugar causes diabetes. Although each focus group had at least 1 adolescent with a family member affected by the disease, only half of the groups cited feeling at risk of diabetes - girls more likely than boys (p≤0.05). CONCLUSION: Healthy adolescents in Moncton, New Brunswick, have a limited comprehension of diabetes, which could make it difficult for them to take preventive action to contain this epidemic disease.

Psychological distress and short-term disability in people with diabetes: results from the Canadian Community Health Survey.

OBJECTIVES: Psychological distress may have different effects on short-term disability depending on individual disease severity, which can affect daily life activities. The objective of this study was to evaluate the interaction between psychological distress and activity limitations in daily life, in relation to self-reported disability days in a community sample of people with diabetes. METHODS: The responses of 3082 adults with self-reported diabetes to the Canadian Community Health Survey Cycle 3.1 were analyzed. RESULTS: Prevalence of disability days was higher in diabetic subjects with coexisting psychological distress and activity limitations (67%) than in individuals with either activity limitations in daily life (38%) or psychological distress (30%) alone. With no psychological distress and no activity limitations as reference and after adjusting for relevant covariates, the odds ratio of disability was 2.63 [95% confidence interval (95% CI)=1.60-4.33] for psychological distress, 5.57 (95% CI=3.86-8.05) for activity limitations, and 19.4 (95% CI=11.7-31.9) for activity limitations and comorbid psychological distress. CONCLUSIONS: The results suggest that there is a joint effect of psychological distress and activity limitations on short-term disability. Detecting and managing psychological distress might be particularly beneficial for persons with diabetes.

Diet in the management of weight loss.

Obesity is an established risk factor for numerous chronic diseases, and successful treatment will have an important impact on medical resources utilization, health care costs, and patient quality of life. With over 60% of our population being overweight, physicians face a major challenge in assisting patients in the process of weight loss and weight-loss maintenance. Low-calorie diets can lower total body weight by an average of 8% in the short term. These diets are well-tolerated and characterize successful strategies in maintaining significant weight loss over a 5-year period. Very-low-calorie diets produce a more rapid weight loss but should only be used for fewer than 16 weeks because of clinical adverse effects. Diets that are severely restricted in carbohydrates (3%-10% of total energy intake) and do not emphasize a reduction of energy intake may be effective in reducing weight in the short term, but there is no evidence that they are sustainable or innocuous in the long term because their high saturated-fat content may be atherogenic. Fat restriction in a weight-loss regimen is beneficial, but the optimal percentage has yet to be determined. Longitudinal trials are needed to resolve these issues. In this article I discuss the evidence for and pitfalls of various types of weight-loss diets and identify issues that physicians need to address in weight loss and weight-loss maintenance.

Canadian dietitians' use and perceptions of glycemic index in diabetes management.

PURPOSE: Several health organizations, including the Canadian Diabetes Association, advocate use of the glycemic index (GI) in the nutritional management of diabetes. However, the clinical utility and applications of the GI remain controversial. Our goal was to determine, via a postal survey, whether dietitians were using the GI and barriers to its use if they were not. METHODS: This cross-sectional study was conducted in 2003. Members of Dietitians of Canada and the Ordre professionnel des diététistes du Québec (n=6,060) were first contacted by mail to identify those working with individuals with diabetes. Among respondents (n=2,857), 1,805 worked with individuals with diabetes and were sent a questionnaire. Using Chi-square analyses, users and nonusers were compared for their professional characteristics, perceived benefits, barriers, general knowledge about the concept, and confidence in teaching the GI. RESULTS: Among questionnaire respondents (n=1,057), 39% (n=415) used the GI and 61% (n=642) did not. Overall, users were more likely to have a greater diabetes patient caseload, perceived greater benefits and had greater confidence in teaching the concept. Nonusers cited lack of teaching tools and lack of knowledge on how to teach the concept as major barriers. CONCLUSIONS: Further research is required to identify the clinical reasoning that triggers dietitians to apply the concept in their practice.

Learning opportunity and preparedness for practice: perceptions from dietetics programs in Canada.

PURPOSE: This study determined dietetics trainees' and program coordinators' perceptions about trainees' preparedness to practice, based on Dietitians of Canada's 145 competency statements. Depth and breadth of learning opportunity were also determined with definitions of these two concepts based on Elliott's view of professional education and practice. METHODS: Research questions were: 1. How prepared were trainees for practice? 2. What were the depth and breadth of learning opportunity in assessment, planning, implementation and evaluation? 3. How many learning opportunities were there in professional practice and communication? 4. Did responses vary between integrated programs and internships or between trainees and program coordinators? RESULTS: Of 313 trainees, 168 (54%) responded and 23 (72%) of 32 coordinators responded. Preparedness was rated as "well prepared" or better for 25 (56%) of the 45 main competencies. For every competency, preparedness ratings were higher in integrated programs than in internships. Learning opportunities were rated as sufficient in depth and breadth or number for 88 (61%) of the 145 competency statements. Low ratings for preparedness were accompanied by low ratings for depth and/or breadth or number of learning opportunities. CONCLUSIONS: The notion of depth and breadth is useful as a framework to assess learning opportunities for developing entry-level competence.

Association between Cardiometabolic Profile and Dietary Characteristics among Adults with Type 1 Diabetes Mellitus.

BACKGROUND: The Mediterranean-style dietary pattern has been associated with several cardiometabolic benefits, yet no study has assessed the potential benefits of this diet in adults with type 1 diabetes mellitus (T1DM). OBJECTIVE: The objective of the present study was to examine the association between cardiometabolic profile and alignment of the diet with 1) Canadian nutrient recommendations for T1DM in terms of fat, protein, carbohydrate, saturated fat, dietary fiber, and sodium and 2) a Mediterranean-style dietary pattern among adults with T1DM. DESIGN/PARTICIPANTS/SETTING: This is a cross-sectional analysis including 118 adults with T1DM recruited between 2011 and 2013 in Montreal, Canada. STATISTICAL ANALYSES: Body mass index (calculated as kg/m(2)), waist circumference, truncal fat percentage (dual-energy x-ray absorptiometry), blood pressure, and lipid profile values were measured. Insulin sensitivity was estimated (estimated glucose disposal rate). A 3-day food record was completed and physical activity was measured with a motion sensor. Differences for the cardiometabolic profile between groups with a diet meeting the Canadian nutrient recommendations for T1DM (percentage of energy from fat, protein, carbohydrate, saturated fat, as well as grams of dietary fiber and milligrams of sodium) or not were examined with general linear models. A Mediterranean diet score was calculated (range=0 to 44) and Pearson correlations between this score and cardiometabolic variables were computed. Significance was set at P≤0.05. RESULTS: Participants' mean ± standard deviation age was 44.3±12.3 years, glycated hemoglobin was 8.0%±1.1%, and Mediterranean diet score was 20.2±5.0. Having a diet that meets at least three nutritional recommendations was associated with a lower truncal fat percentage (28.0% vs 32.2%; P=0.01) only. In contrast, the Mediterranean diet score was inversely correlated with body mass index (r=-0.30, P=0.002), waist circumference (r=-0.31, P=0.002), truncal fat percentage (r=-0.38, P<0.001), systolic (r=-0.20, P=0.03) and diastolic blood pressure (r=-0.23, P=0.01), and was directly correlated with estimated glucose disposal rate (r=0.22, P=0.03), after adjustments for energy intake, sex, and age. The association with estimated glucose disposal rate was no longer significant (P=0.055) after adjustment for physical activity level. CONCLUSIONS: These results suggest that a higher Mediterranean diet score in the context of T1DM is associated with a favorable cardiometabolic profile. Further research is needed to confirm these findings.

Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool.

OBJECTIVE: This study aims to assess middle-aged women's needs when making body weight management decisions and to evaluate a knowledge translation tool for addressing their needs. METHODS: A mixed-methods study used an interview-guided theory-based survey of professional women aged 40 to 65 years. The tool summarized evidence to address their needs and enabled women to monitor actions taken. Acceptability and usability were reported descriptively. RESULTS: Sixty female participants had a mean body mass index of 28.0 kg/m(2) (range, 17.0-44.9 kg/m(2)), and half were premenopausal. Common options for losing (82%) or maintaining (18%) weight included increasing physical activity (60%), eating healthier (57%), and getting support (40%). Decision-making involved getting information on options (52%), soliciting others' decisions/advice (20%), and being self-motivated (20%). Preferred information sources included written information (97%), counseling (90%), and social networking websites (43%). Five professionals (dietitian, personal trainer, occupational therapist, and two physicians) had similar responses. Of 53 women sent the tool, 27 provided acceptability feedback. They rated it as good to excellent for information on menopause (96%), body weight changes (85%), and managing body weight (85%). Most would tell others about it (81%). After 4 weeks of use, 25 women reported that the wording made sense (96%) and that the tool had clear instructions (92%) and was easy to use across time (88%). The amount of information was rated as just right (64%), but the tool had limited space for responding (72%). CONCLUSIONS: When making decisions about body weight management, women's needs were "getting information" and "getting support." The knowledge translation tool was acceptable and usable, but further evaluation is required.

Impact of a high-monounsaturated-fat diet on lipid profile in subjects with type 1 diabetes.

OBJECTIVE: Controversy persists regarding the use of a high-monounsaturated-fat diet in people with type 1 diabetes. The purpose of this study was to compare the effects of a high-monounsaturated-fat diet containing 43% to 46% carbohydrates and 37% to 40% fat (17% to 20% monounsaturated fat) with those of a high-carbohydrate diet containing 54% to 57% carbohydrates and 27% to 30% fat (10% to 13% monounsaturated fat) on the quantitative and qualitative lipoprotein profile in type 1 diabetes. DESIGN: A randomized crossover study was conducted. Two months before the dietary trial, subjects were monitored on their intensive insulin regimen to normalize glycemic and lipid levels. SUBJECTS: Twenty-six individuals followed each diet for 2 months. Eight subjects lost or gained >2 kg, and three had the same dietary intakes during the two diets. For the remaining 15, seven adhered to the two diet prescriptions and eight followed one of the two diets. STATISTICAL ANALYSIS: Analysis of variance for crossover design (intent-to-treat group of 26) and Wilcoxon signed rank test (group of seven) were used to assess differences between the two diets. RESULTS: For the intent-to-treat group (n=26), low-density lipoprotein cholesterol, although within normal range, was lower by 7% (P=.034) at the end of the high-monounsaturated-fat diet. The other 17 lipid parameters tested were not statistically significant. For those who adhered to the two diets (n= 7), lower plasma total triglycerides by 18% (P=.027), lower very low-density lipoprotein triglycerides by 26% (P=.043), lower very low-density lipoprotein cholesterol by 48% (P=.043), higher apolipoprotein A1 by 7% (P=.018), smaller low-density lipoprotein particle size by 1% (P=.043), and longer low-density lipoprotein oxidation lag time by 25% (P=.043) were found after the high-monounsaturated-fat diet. APPLICATIONS/CONCLUSIONS: A high-monounsaturated-fat diet seemed to have a favorable effect on fasting lipoprotein profile in people with type 1 diabetes. Further research is needed with a larger sample to recommend a high-monounsaturated-fat diet as an alternative diet therapy in type 1 diabetes.

Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.

AIMS: To describe (i) current bedtime nutritional practices and (ii) the association between post-dinner dietary intake and the occurrence of non-severe nocturnal hypoglycemia (NH) in real-life conditions among adult patients with type 1 diabetes using insulin analogs. METHODS: One hundred adults (median [interquartile range]: age 46.4 [36.0-55.8] years, HbA1c 7.9 [7.3-8.6] % (63 [56-70] mmol/mol)) using multiple daily injections (n=67) or insulin pump (n=33) wore a blinded continuous glucose monitoring system and completed a food diary for 72-h. RESULTS: NH occurred on 28% of 282 nights analyzed. (i) Patients reported post-dinner dietary intakes on 63% of the evenings. They injected rapid-acting insulin boluses on 64 occasions (23% of 282 evenings). These insulin boluses were mostly injected with (n=37) dietary intakes. (ii) Post-dinner dietary intake was not associated with NH occurrence in univariate analyses. In multivariate analyses, the injection of rapid-acting insulin modulated the association between post-dinner dietary intake and NH: with insulin, post-dinner carbohydrate intake was positively associated with NH (odds ratio (OR): 1.16 [95% confidence interval, CI: 1.04-1.29] per 5g increase, p=0.008); without insulin, post-dinner protein intake was inversely associated with NH occurrence (OR [95% CI]: 0.88 [0.78-1.00] per 2g increase, p=0.048). CONCLUSIONS: NH remains frequent in adults with type 1 diabetes. There is a complex relationship between post-dinner dietary intake and NH occurrence, including the significant role of nutrient content and rapid-acting insulin injection that requires further investigation.

Recurrent subthreshold depression in type 2 diabetes: an important risk factor for poor health outcomes.

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health-related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health-related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Lifestyle interventions targeting body weight changes during the menopause transition: a systematic review.

OBJECTIVE: To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition. METHODS: A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively. RESULTS: Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns. CONCLUSIONS: High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity.

Weight cycling and depressive symptoms in diabetes: a community-based study of adults with type 2 diabetes mellitus in Quebec.

OBJECTIVE: The problems of obesity and depression in type 2 diabetes mellitus are well documented, yet the role of weight cycling in relation to these 2 chronic conditions has not been examined. The study objective was to determine whether weight cycling predicts the development of depressive symptoms in the course of 1 year. METHODS: A cohort study of 1100 adults with type 2 diabetes participating in the Diabetes Health and Well-Being Study (telephone survey using the random-digit-dialling method) had complete data at the 1-year follow up on depressive symptoms (Patient Health Questionnaire 9) and weight cycling frequency (going on a diet and losing >10 kg). RESULTS: At baseline, 56.5% of subjects reported weight cycling on at least 1 occasion in their lifetime; it was found to be associated with baseline body mass index, depression, sex and age (p<0.05). Regression analyses indicated that severe weight cycling (≥4 times) was not associated with the development of major depressive symptoms; however, it was associated with maintaining major depressive symptoms (p=0.038) but significance disappeared after adjusting for body mass index, physical activity, smoking and sociodemographic characteristics. Development and maintenance of major depressive symptoms were associated with physical inactivity (p<0.05); maintenance of major depressive symptoms was also associated with higher body mass index values (p<0.05). CONCLUSIONS: Weight cycling is a widespread phenomenon in diabetes. It was associated with depression, but severe cycling was not an independent predictor of the development and maintenance of major depressive symptoms. Clinicians should consider physical inactivity when evaluating and addressing depression in patients with type 2 diabetes.